| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,740 |
2,669 |
$108K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,340 |
617 |
$93K |
| D1110 |
Prophylaxis - adult |
758 |
745 |
$48K |
| D0330 |
Panoramic radiographic image |
391 |
383 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
911 |
777 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
396 |
392 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
510 |
242 |
$16K |
| D1120 |
Prophylaxis - child |
2,448 |
2,385 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,279 |
3,198 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
452 |
223 |
$8K |
| D1351 |
Sealant - per tooth |
1,224 |
350 |
$4K |
| D0240 |
|
2,437 |
2,254 |
$4K |
| D0272 |
Bitewings - two radiographic images |
1,990 |
1,929 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
914 |
745 |
$2K |
| D1330 |
|
3,291 |
3,208 |
$2K |
| D0274 |
Bitewings - four radiographic images |
729 |
716 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
788 |
787 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
51 |
49 |
$505.47 |
| D9999 |
Unspecified adjunctive procedure, by report |
13 |
13 |
$260.00 |